Adrenal Disorders- Ochs

based off pp

What regulates glucocorticoids? (This is suppressed when too many steroids are taken)

HPA axis

What are the main ADRs of corticosteroids?

• immunosuppression

• hyperglycemia

• mood swings

• adrenal suppression

What is adrenal suppression refer to?

When the HPA axis is suppressed due to exogenous supplementation of steroids.

What is the solution to avoiding adrenal suppression with steroids?

TAPER

You must taper steroids if a patient receives systemic corticosteroids ≥____ days with a prednisone equivalent of ≥_____mg.

14, 20

What are the glucocorticoids and their equivalent potencies?

• Glucocorticoid	Equivalent potency (mg)
  Cortisone	25
  Hydrocortisone	20
  Prednisone	5
  Prednisolone	5
  Methylprednisolone	4
  Triamcinolone	4
  Dexamethasone	0.75
  Betamethasone	0.6

What are some counseling points with corticosteroids?

• take in the morning

• give lowest dose for shortest duration

• take with food

• avoid abrupt discontinuation

Cushing’s Syndrome can be caused by exogenous and _____________ overproduction.

endogenous

What are the symptoms of cushing’s syndrome?

• moon face

• buffalo hump

• weight gain

• HTN

• glucose intolerance

What 3 classes of medications can be used to treat cushing’s?

1. steroid synthesis inhibitors

2. ACTH inhibitors

3. Glucocorticoid receptor antagonists

What steroid synthesis inhibitors can be used in Cushing’s?

• ketoconazole

• etomidate

• mitotane

• metyrapone

What ACTH inhibitors can be used in Cushing’s?

• cabergoline

• pasireotide

What Glucocorticoid receptor antagonist is used to treat Cushing’s?

mifepristone

What are the symptoms of primary hyperaldosteronism?

• hypernatremia

• hypokalemia

• HTN

• muscle weakness/fatigue

• HA

What is the main pharm tx for primary hyperaldosteronism?

spironolactone

What two symptoms are seen in primary adrenal insufficiency and not in secondary adrenal insufficiency?

hyperkalemia and hyperpigmentation

What are the symptoms of primary adrenal insufficiency or Addison’s disease?

• bronze skin

• low sugar

• weight loss

• postural hypotension

What glucocorticoids are preferred to treat Addison’s disease?

• hydrocortisone

• cortisone

• prednisone

When dosing glucocorticoids for Addison’s disease, you should give _____% in the morning and ____% 6-8 hours later.

you should give 67% in the morning and 33% 6-8 hours later.

If you have Addison’s disease and are doing strenuous activities or exercise you should take ___-___mg hydrocortisone before.

5-10mg

In primary adrenal insufficiency or Addison’s disease what drug should be used to supplement mineralocorticoid loss?

fludrocortisone

What is the most common cause of an adrenal crisis?

abrupt steroid withdrawl

How do you treat an adrenal crisis?

100 mg IV bolus of hydrocortisone followed by continuous infusion for 24-48 hours

What medication can be used to treat hypoaldosteronism?

fludrocortisone

What is Hirsutism and how is it treated?

hirsutism is excessive hair growth in androgen-dependent distribution. treated with cosmetic approaches first (wax, shave) then 1st line is oral contraceptives.